What is HELLP syndrome?

HELLP syndrome is a rare and serious pregnancy condition that affects blood and the liver. It's often described as a type of severe preeclampsia or a complication of the condition. Like preeclampsia, it can develop during pregnancy or after delivery.

HELLP stands for:

Hemolysis, which means red blood cells are broken down or destroyed.

Elevated liver enzymes, which is a sign that the liver isn't working properly.

Low platelet count, which means that you may not have enough platelets for your blood to clot.

HELLP syndrome is a medical emergency. Without prompt treatment, it can be life-threatening to you and your baby.

Am I at risk of HELLP syndrome?

HELLP syndrome happens in less than 1 percent of all pregnancies. However, among women who develop severe preeclampsia, about 20 percent will get HELLP syndrome. If you had HELLP in a previous pregnancy, there's a strong likelihood you could get it again (as well as preeclampsia or gestational hypertension) in another pregnancy.

HELLP syndrome can also run in families, so be sure to let your healthcare provider know if your mom or a sister had HELLP syndrome. Having a close relative who had HELLP doesn't necessarily mean you'll get it, but it might put you at higher risk.

What are the symptoms of HELLP syndrome?

HELLP syndrome usually develops in the third trimester, but it can happen earlier in pregnancy, or even after your baby is born. The condition can include other signs or symptoms of preeclampsia, but it doesn't always. The symptoms of HELLP can feel like flu at first.

If you have HELLP, you might feel tired and generally unwell. After a couple of days, other symptoms may include:

Pain on the right side of your abdomen, just below your ribs (This pain may come and go.)

Nausea or vomiting

Jaundice (yellow tint to the skin or eyes)

Easy bruising or bleeding

Call your provider right away if you have any of these symptoms.

How is HELLP syndrome diagnosed?

HELLP syndrome can be mistaken for other conditions, so your provider will do a physical exam to check for swelling in your legs and tenderness in the upper right section of your belly where your liver is located. Tenderness in this area could indicate that the liver is enlarged, which is a sign that something is wrong.

Your provider will also do a number of tests to confirm the diagnosis. Your provider will check your blood pressure and test a urine sample for protein. High blood pressure and protein in urine are signs of preeclampsia, which can develop into HELLP.

(If you have preeclampsia, you'll be monitored closely for signs of HELLP because the condition almost always follows preeclampsia, even without other severe symptoms.)

But even women who don't have the symptoms of preeclampsia can still get a diagnosis of HELLP syndrome, so your provider will also do blood tests to check your red blood cell count and platelet levels. A low blood cell count and platelet level are both signs of HELLP. Blood tests can also reveal evidence of liver damage.

To get a diagnosis of HELLP you must have all three aspects of the syndrome:

A low red blood cell count

Elevated liver enzymes

Low platelet level

Your provider will also want to know how your baby is doing, so it's likely you'll have an ultrasound to check on your baby's growth, and possibly a biophysical profile and nonstress test to assess your baby's well-being.

If your healthcare provider confirms that you have HELLP syndrome and you're less than 34 weeks pregnant, you may be transferred to a hospital where a maternal-fetal medicine specialist can care for you.

What is the treatment for HELLP syndrome?

As with preeclampsia, delivering your baby is the only cure for HELLP. You may have your labor induced, or in some cases, you may have a cesarean (c-section). It depends on how far along you are in your pregnancy.

If you've reached 34 weeks of pregnancy, you'll likely have your baby as soon as your provider can prepare you for delivery. That might mean giving you medication to lower your blood pressure and to prevent seizures (eclampsia).

You may also need a platelet transfusion if your platelet count is very low, or if you've experienced any bleeding. Without a transfusion, having a low platelet count could put you at risk of losing too much blood during your baby's birth.

A very low platelet count can also limit your options for pain relief during delivery because there's a small risk that having a spinal or epidural anesthetic could cause a spinal epidural hematoma, which is when blood collects in your spine and puts pressure on your spinal cord.

If you have a vaginal delivery, your provider will offer alternative pain relief. Options include local anesthetic injections or drugs delivered intravenously. If you're going to have a c-section and you're at risk of an epidural hematoma, your provider may recommend that you have general anesthesia.

If you've not yet reached 34 weeks of pregnancy, your provider may try to delay your labor for between 24 and 48 hours if it's safe for you and your baby. During this time, you'll be given drugs to help your baby's lungs mature (corticosteroids). These may also raise your platelet count.

You'll be monitored closely after you deliver your baby to make sure that your body is no longer breaking down your red blood cells too quickly (hemolysis), and that there are no further signs of liver damage. Levels usually start to improve within 48 hours of delivery.

How could HELLP affect my pregnancy and my baby?

HELLP syndrome is a medical emergency that can lead to a number of life-threatening complications, including:

Kidney failure

Breathing difficulties

Fluid in the lungs

Abnormal blood clotting or bleeding

Stroke

Blood collection in the liver

Problems with the blood supply to your liver or liver failure

Problems for a baby are most commonly linked to preterm labor and delivery because if you develop HELLP, your baby may need to be born very quickly, regardless of how far along in your pregnancy you are.

HELLP can also affect a baby if the placenta partially or completely separates from the uterus (placental abruption) and the baby doesn't get enough oxygen.

The risks of complications for you and your baby mean the best place for you to deliver is in a hospital, which can provide specialist care from a maternal-fetal medicine specialist.

Is there anything I can do to avoid HELLP syndrome?

Unfortunately, there's no way to prevent HELLP syndrome. Having good prenatal care and going to all your appointments is probably the most important thing you can do.

At each visit, your provider will check for signs of preeclampsia, such as high blood pressure and protein in your urine. Since preeclampsia can lead to HELLP syndrome, being aware of preeclampsia symptoms is important too, so you can get treatment as soon as possible.

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